Clarifying status indicator ’S’ and ’T’ procedures

APCs Insider, July 7, 2005

Q: We have a question about Medicare status indicators and procedure discounting. If a claim contains two APCs, one of which has a status indicator 'S', and the other has a status indicator 'T', is either one discounted? What if the 'T' status APC has a higher weight?

If both are 'T' or both 'S', which one is discounted? Will a discount apply only if there are multiple APCs with a status indicator 'T'? We have searched the CMS Web site, but cannot find a definitive answer.

A: You can find the answer to your question in the 'S' and 'T' status indicator descriptions. Status indicator 'S' represents a significant procedure, and is not discounted when you report multiple CPT codes that group to APCs with multiple 'S' status indicators. Status indicator 'T' is also a significant procedure, but multiple procedure reduction applies.

To answer your specific questions, if there are only two APCs present on a claim (i.e., an ED claim with 12001-59, which has a status indicator of 'T', and 29105-LT, which has a status indicator 'S'), the outpatient code editor identifies both with respective relative weights and status indictators, and both are reimbursed at 100% of APC payment. Neither are discounted because of the singular status indicators reported on the claim.

If both CPT codes group to status indicator 'S' procedures (i.e. CT scans), then neither is discounted under OPPS and both are paid 100% of APC payment. Remember that in some cases, medical necessity applies before APC payment is made.

If both CPT codes have a 'T' status indicator, the one with the highest relative weight will be paid at 100% APC payment. Any additional procedures with a status indicator 'T' will be discounted 50% of their APC payment. Remember that with status indicator 'T', there is no limit the number of CPT codes that you can report, as long as you follow CPT rules and guidelines and include complete medical record documentation.

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